Establishing a robot-assisted kidney transplantation program in a RAKT-naïve transplant center: initial clinical experience from Thailand

Abstract Background Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative to conventional open kidney transplantation. Evidence regarding the feasibility of establishing RAKT programs in RAKT-naïve transplant centers remains scarce. Methods Between March 2024 and May 2025, ten consecutive adult recipients underwent living donor RAKT at a RAKT-naïve transplant center in Thailand. The first three cases were performed under in-room proctorship after structured overseas training, and cases 4–10 were performed independently. Outcomes were assessed descriptively by proctored and independent phases. The primary outcome was total operative time. Secondary outcomes included ischemia and arterial, venous, and ureterovesical anastomosis times, blood loss, pain and analgesic use, 30-day readmission, perioperative complications, and graft function. Results All procedures were completed robotically without conversion or intraoperative transfusion. Median total operative time was 290 min during the proctored phase and 420 min during independent practice; median total vascular anastomosis time was 48 and 60 min, respectively. Median recipient warm ischemia time was 47 min (range, 38–56; n = 2) and 90 min (range, 69–110; n = 7), respectively. Median donor warm ischemia time was 5 min in both phases, and median blood loss was 400 and 200 mL, respectively. No delayed graft function, primary non-function, or graft thrombosis occurred. Thirty-day surgical complications included one Clavien–Dindo grade II sigmoid hematoma and one grade IIIa ureteral leak requiring percutaneous drainage under local anesthesia; one acute antibody-mediated rejection episode was reported separately as an immunologic event. No reoperations, graft loss, or mortality occurred. Graft function remained preserved among those with follow-up data. One 30-day readmission occurred in the independent phase. Conclusions These preliminary findings suggest that RAKT may be feasibly introduced in carefully selected patients at RAKT-naïve transplant centers when structured training and expert proctorship are available. These findings should be interpreted within the context of a highly selected initial cohort with favorable vascular anatomy.